Provider Demographics
NPI:1841306206
Name:LECLOUX, CYNTHIA L (APNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:LECLOUX
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-2840
Mailing Address - Fax:
Practice Address - Street 1:3310 45TH ST
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-1049
Practice Address - Country:US
Practice Address - Phone:920-793-3900
Practice Address - Fax:920-793-1542
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43936600Medicaid
P22581Medicare UPIN
WI001938170Medicare ID - Type Unspecified